Macrodystrophia Lipomatosa: A Rare Case of Ulnar Nerve Territory Involvement.

Macrodystrophia lipomatosa (MDL) is a rare congenital, nonhereditary anomaly characterized by overgrowth of all the mesenchymal elements, predominantly the fibroadipose tissue in a sclerotomal distribution commonly involving the median nerve territory in the upper extremity and plantar nerve territory in the lower extremity. It can be either static or progressive, with the former being the more common. MDL is usually present since birth and the affected digit/region increases in length and girth, and growth ceases after puberty. We discuss a rare case of ulnar nerve territory involvement that progressed to grow even after puberty.

Validity of ultrasound with color Doppler to differentiate between benign and malignant ovarian tumours.

OBJECTIVE: To assess the utility of ultrasound and color Doppler and the Accuracy of International Ovarian Tumor Analysis (IOTA) group classification in the preoperative evaluation of ovarian neoplasms to assess benign or malignant histopathology in the diagnosis of ovarian tumors. METHODS: This observational longitudinal prospective analysis of 60 patients was performed over a period of 2 years (2017- 2019). The mean age of the patients was 43.75 years. Ultrasonography of ovarian masses were evaluated, and cancer antigen-125 (CA-125) levels were evaluated. Based on the IOTA classification, the B and M features of adnexal masses were studied. Color Doppler imaging was performed to evaluate the patterns of vascularity and indices. RESULTS: Sixty patients with 35 benign, 23 malignant, and two borderline lesions were included in the study. In malignant lesions, 17 women (73.9%) were above the age of 45. The CA-125 cut off was ≥35 internatioal units/mL. Based on the IOTA classification, 27/35 (77.1%) benign cases, were correctly identified as benign, 6/35 (17.1%) benign cases were incorrectly identified as malignant, and two (5.7%) were found to be inconclusive. In the malignant group, 17 of the 23 patients were identified as having malignancy. Color Doppler showed three (18.8%) benign tumors had a pulsatality index (PI) of <0.8 and 21 malignant tumors had a PI of <0.8. Four benign tumors had an resistive index (RI) of <0.6 and 100% of malignant tumors had an RI <0.6. CONCLUSION: The IOTA classification is a reliable scoring system for adnexal masses, and color Doppler can help to minimize interobserver variation.

Post-COVID-19 sequelae in lungs: retrospective computed tomography analysis in selected tertiary care hospitals of Mangalore.

Purpose: The radiological features of COVID-19 during the active disease process are well established, but the radio-logical features in the convalescent and post-recovery period of the disease are still unclear. The objectives of this study are to document and assess the proportion of the residual changes in lung post COVID-19 infection and to look for evidence and the proportion of fibrosis post COVID-19 infection on high-resolution computed tomography (HRCT). Material and methods: HRCT thorax of COVID-positive cases done during the disease process and in the recovery/post recovery phase were included in the study. Sample Size: 75. Categorical data are represented in the form of frequencies and proportions. The c2 test was used as a test of significance for qualitative data. Continuous data are represented as mean and standard deviation. A p-value (probability that the result is true) of < 0.05 was considered as statistically significant after assuming all the rules of statistical tests. Results: Initial computed tomography (CT) findings mainly included ground glass opacity (GGO) (93.3%), inter-lobular septal thickening (66.7%), consolidation (52.0%), and fibrotic bands (8.0%). Ninety-two per cent of the CT scans demonstrated some pulmonary change in the follow-up CT. This was mostly in the form of GGO (58%). Approximately 17% of cases showed fibrotic changes in the follow-up CT. Conclusions: Post-COVID lung sequelae can be present in a significant number of patients. This are mostly seen in patients with severe initial disease and in older patients. Statistically significant post-COVID sequelae changes include GGO, fibrotic bands, and bronchiectasis.

A myriad spectrum of seizures on magnetic resonance imaging - A pictorial essay.

Patients with seizures represent a challenging clinical population both in pediatrics and adults. Accurate diagnosis of the cause of a seizure is important in choosing an effective treatment modality, surgical planning, predicting a prognosis, and follow-up. Magnetic resonance (MR) imaging using a dedicated epilepsy protocol plays a key role in the workup of these patients. Additional MR techniques such as T2 relaxometry and MR spectroscopy show a promising role to arrive at a final diagnosis. The spectrum of epileptogenic causes is broad. Radiologists and physicians need to be updated and require a patterned approach in light of clinical history and electroencephalogram findings to arrive at a reasonable differential diagnosis. This pictorial essay aims to review a few of the common and uncommon causes of seizures and their imaging features.

Computed Tomography and Cephalometric Evaluation of Obstructive Sleep Apnea Syndrome.

To examine the changes of upper airway cross sectional area in each phase of respiration in different degrees of severity of OSAS with computed tomography and cephalometry to decide on further treatment. A Prospective study was done in the Department of Radiology and Imaging, Kasturba Medical College, Mangalore, spanning over a period from March 2017 to December 2019. 50 patients were included in the study including control group. Patients who had at least 2-3 major symptoms of sleep apnea such as snoring, daytime somnolence, and apnea were included in this study. All patients were examined and then subjected to polysomnography(PSG) and upper airway CT. Patients with apnea-hypopnea index (AHI) of < 5 on Polysomnography were included in the control group and those with AHI of > 5 were categorized in to the study group Cross-sectional area of the airway at the level of the nasopharynx, oropharynx and the hypopharynx were obtained. Standard cephalometric measurements were made on a lateral radiograph of skull/ CT scanogram. Of the 36 patients in the study group, 31 patients were males and 5 were females. In the control group of 12 patients, 8 were males and 4 females. The cross sectional area at the lower border of the nasopharynx which is also the level of the nasopharyngeal sphincter was the most affected level in OSAS (p value of < 0.0001). Mean uvular diameter in the control group was 9.6 mm and in the OSAS group it was 11.2 mm. The mean length of the soft palate was 36.4 mm in the controls, 39.5 mm in the mild/moderate OSAS and 41.2 mm in the severe OSAS group. Obstructive sleep apnea is a complex disorder characterized by apneic episodes during sleep. In this study the most common site of obstruction is nasopharyngeal sphincter and the oropharynx. Although PSG is the diagnostic test of choice, imaging plays an important role in planning surgical and conventional treatment.

Lean Cushing's.

This is a case report of 59 years old male with adrenocorticotropic hormone ACTH-independent macronodular adrenal hyperplasia (AIMAH), which is a rare cause of Cushing's syndrome. He was detected to have adrenal lesions incidentally on imaging. The biochemical evaluation was suggestive of endogenous ACTH-independent Cushing's syndrome. Contrast Enhanced CT of the abdomen done to characterize the lesion was suggestive of bilateral macro-nodular adrenal hyperplasia. There was no evidence of cushingoid features except for type 2 diabetes mellitus suggestive of subclinical Cushing's. He was not planned for any immediate medical/surgical management since metabolic control was achieved with oral anti-diabetics (OADs) and anti-hypertensive medications. He is on regular follow up with well-controlled sugars and blood pressure.

Postcontrast Fluid-Attenuated Inversion Recovery (FLAIR) Sequence MR Imaging in Detecting Intracranial Pathology.

BACKGROUND: Imaging sequences for detection of meningeal and parenchymal lesions are critical in intracranial pathology. Our study analysed FLAIR MRI sequence for evaluating postcontrast enhancement. OBJECTIVES: FLAIR imaging sequences have been used in evaluation of enhancement in the brain. We conducted a study of FLAIR imaging sequences to better delineate postcontrast enhancement. MATERIALS AND METHODS: In this prospective hospital-based observational study, postcontrast T1 MTC and delayed postcontrast T2 FLAIR and T1 FLAIR images of 66 patients with intracranial pathology were assessed by experienced radiologists from November 2017 to November 2019. RESULTS: 28 cases of meningeal enhancement were identified in delayed postcontrast T2 FLAIR images. Low-grade gliomas included in the study showed postcontrast enhancement on postcontrast T1 MTC images. Multiple sclerosis lesions were better seen on postcontrast T1 FLAIR. In extraaxial lesions of 11 cases of meningioma, brighter enhancement was seen on delayed postcontrast T2 FLAIR images. CONCLUSION: We found that delayed postcontrast T2 FLAIR was better in detection of meningeal enhancement in infectious meningitis and in meningitis carcinomatosis than T1 MTC images. In delayed postcontrast T2 FLAIR images, intra-axial parenchyma lesions appeared more conspicuous or similar to T1 MTC images. Delayed postcontrast T1 FLAIR images provided better anatomic delineation of intra-axial lesions.

A rare case of epidermoid cyst in urinary bladder.

Epidermoid cyst in urinary bladder is a rare pathology with only one known case published prior to this study. In this article, we described imaging findings of epidermoid cyst in the urinary bladder and other parts of urogenital system. Plain CT KUB was performed on Multidetector 16 slice computed tomography scanner-GE Bright speed Elite and plain magnetic resonance imaging on 1.5 T Siemens Magnetom Avanto.

Clinical relevance of reporting fatty liver on ultrasound in asymptomatic patients during routine health checkups.

OBJECTIVE: Ultrasonography is an efficient technique for detecting fatty liver. Its sensitivity and specificity in detecting moderate to severe fatty liver are comparable to those of histology. Fatty liver is associated with abnormal lipid and lipoprotein metabolism and insulin resistance, metabolic syndrome, cardiovascular/renal disease, type 2 diabetes, and other conditions. This study was performed to compare the serum lipid profiles and serum glutamic pyruvic transaminase (GPT), glutamic oxaloacetic transaminase (GOT), and glycosylated hemoglobin (HbA1c) levels in patients diagnosed with fatty liver on ultrasonography versus controls without fatty liver and evaluate the clinical relevance of an ultrasound diagnosis of fatty liver in routine health checkups. METHODS: This hospital-based cross-sectional study included 390 patients who underwent health checkups; 226 were diagnosed with fatty liver (cases) and 164 were not (controls). The lipid profile, serum GOT and GPT levels, and HbA1c level were compared between the cases and controls. RESULTS: The cases had considerably higher levels of lipids, liver enzymes (serum GOT and GPT), and HbA1c than controls. CONCLUSION: Ultrasonography is a noninvasive simple tool for early detection of fatty liver in asymptomatic patients and can help clinicians achieve early detection of metabolic syndrome.

A Rare Case of Fetus within a Fetus.

We present a case of a 45-day-old baby brought to our paediatric outpatient department with complaints of abdominal distension. The prenatal ultrasonographic examination showed a large cystic intrabdominal mass with internal calcifications.

Accuracy of Pelvic Mass Score in Pre-operative Determination of Malignancy in Adnexal Masses.

INTRODUCTION: Suspicious adnexal masses are common clinical problems in gynaecological practice. A reliable diagnostic tool for the early detection of the ovarian malignancy is essential. AIM: To validate a new scoring system -Pelvic Mass Score (PMS) in predicting the nature of the adnexal mass pre-operatively. MATERIALS AND METHODS: A prospective observational study was carried out in 100 consenting women with an undiagnosed adnexal mass requiring operative intervention. Among them 62 patients had mass with a feeding vessel in which the Doppler velocimetry study values were available. The PMS was determined in these 62 patients. A score of 29 or more was taken as suggestive of malignancy. The results were compared with the histopathological diagnosis to confirm malignancy. The chi-square test was applied to test the significance. RESULTS: Among the 62 patients with vascular mass, 31 had histopathological diagnosis of malignancy. The statistical analysis of the data with PMS with 29 as cut-off revealed 100% sensitivity and 100% Negative Predictive Value (NPV) as there was no false negative case detected. But the specificity and Positive Predictive Value (PPV) was poor; 45.2% and 64.6% respectively. Based on the Receiver Operating Characteristic (ROC) curve, if we redefine cut-off as 69, specificity increases to 80.6% with a sensitivity of 90.3%, the PPV and NPV being 82.35 and 89.29 respectively. CONCLUSION: The present study concludes that, in suspicious vascular adnexal masses PMS can be used as a reliable diagnostic score to predict malignancy if we redefine the existing cut-off of 29 to 69.

In vivo morphometry of menisci of the knee in South Indians: a preliminary study.

BACKGROUND: Since the in vivo morphometric data on the menisci of the knee joint of Indian subjects are scarce, we hereby studied the width and thickness of the menisci using Magnetic Resonance Imaging (MRI) to establish standard dimensions of the normal medial and lateral meniscus as an aid to orthopaedic surgery. METHODS: Eighty menisci from 40 knee joints were analysed in each of three regions, the anterior horn, the mid body and the posterior horn. The thickness and width of the menisci were measured in sagittal and coronal T1-weighted and T2-weighted MRI images and analysed statistically. RESULTS: The mean thickness of medial meniscus at the anterior horn, mid body, and posterior horn were 6.3 ± 1.1 mm, 5.2 ± 1.3 mm, and 6.9 ± 1.1 mm, respectively. The respective values for the lateral meniscus were 4.8 ± 0.7 mm, 6.4 ± 1.1 mm, and 7.0 ± 0.9 mm. The mean width of medial meniscus at the anterior horn, mid body, and posterior horn were 10.5 ± 1.2 mm, 7.8 ± 1 mm and 13.9 ± 0.9 mm, respectively. The widths of lateral meniscus at the same regions were 11.8 ± 1.4 mm, 8.6 ± 1.2 mm, and 12.0 ± 0.9 mm, respectively. The lateral meniscus was significantly wider than medial at the anterior horn and mid body (p = 0.00). In contrast, the posterior horn of medial meniscus was significantly wider than lateral meniscus. Both menisci were significantly wider at their posterior horn, followed by the anterior horn and were significantly narrower at their mid body. CONCLUSION: The present study provides new information on the meniscal thickness and width in South Indians that can be used in planning of orthopaedic and arthroscopic surgeries of the knee joint. However, the study needs to be analyzed with a large sample size for the better interpretation.

Hemifacial microsomia.

Hemifacial microsomia (HFM) is a craniofacial disorder characterized by a wide spectrum of anomalies, including conductive hearing loss due to external and middle ear deformities [1]. Hemifacial microsomia is the second most common developmental craniofacial anomaly after cleft lip and palate. Diagnostic imaging is important for presurgical evaluation of patients with this anomaly; however the broad spectrum of abnormalies encountered in patients with hemifacial microsomia can be confusing [2]. We present a case of a hemifacial microsomia in 12 year old male.